1568672376 NPI number — METRO SPINE PAINCENTER, L.L.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568672376 NPI number — METRO SPINE PAINCENTER, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO SPINE PAINCENTER, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568672376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10777 NALL AVE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211-1231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-387-2800
Provider Business Mailing Address Fax Number:
913-387-2970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10777 NALL AVE
Provider Second Line Business Practice Location Address:
SUITE130
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-387-2800
Provider Business Practice Location Address Fax Number:
913-387-2970
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GALATE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
913-387-2800

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  PENDING , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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